Integrated care: healthy mouth, healthy body

Since my first day of dental school some 37 years ago, the significance of good oral health has always been a topic of great importance. Research continues to associate oral health with overall health. Periodontal disease may have a potentially significant impact on systemic health, and the implications for cost of care and quality of life can be staggering.

In 2013, Cigna published a national study, (1) analyzing its own medical and dental claims among other factors, that highlights an adverse association between untreated periodontal disease and higher medical costs for individuals with diabetes, heart disease, and stroke.

For example, the average annual medical savings for those individuals in the study who had one of these medical conditions but also received appropriate periodontal care was as follows:

• Diabetes: $1,292
• Heart disease: $2,183
• Stroke: $2,831

Findings also indicated a $1,020 average medical savings per person per year for individuals with periodontal disease who received appropriate care, regardless of whether or not they had an underlying medical condition. Why? The study found that individuals who received appropriate preventive dental treatment have, on average, 12.5% fewer extractions and 5.4% fewer root canals. Furthermore, individuals with periodontal disease who are receiving appropriate periodontal care have a 67% lower hospital admission rate and 54% lower ER rate.

Some insights by condition include:

• Diabetes. Individuals with diabetes are more likely to have periodontal disease than people without diabetes, because they are more at risk of getting infections. Inflammation that starts in the mouth may weaken the body’s ability to control blood sugar. The estimated economic cost of diabetes in 2012 was estimated at $245 billion, a 41% increase over a five-year period. More than one in five health-care dollars in the United States is spent caring for someone diagnosed with diabetes. (2)
• Cardiovascular disease or stroke. Periodontal disease and heart disease are often present together. Up to 91% of patients with heart disease have periodontitis, compared to 66% of people with no heart disease. The two conditions have several risk factors in common, such as smoking, unhealthy diet, and excess weight. And some suspect that periodontitis has a direct role in raising the risk for heart disease as well. (3)
• Pregnancy and prematurity. Pregnancy can increase the risk for periodontal disease because of hormonal changes and can worsen existing dental problems. Several studies have shown that periodontal disease may increase the risk for low birth weight and preterm labor. The medical costs that businesses pay to care for one premature baby for a year could cover the costs of 10 healthy, full-term infants ($49,000 vs. $4,550). When combined, maternity and first-year costs for a premature baby were four times as high as those for a baby born without any complications ($64,713 and $15,047, respectively). (4)

As health-care professionals, we can continue to educate patients as to the importance of good oral health and its impact on overall health and even medical costs. Keeping current and thorough medical histories is a key for informing patients of this association.

Armed with research and findings showing the impact of medical/dental integration will help the public understand why going to the dentist is so important.

Miles Hall, DDS, is Cigna Dental’s chief clinical director. In this role, he helps develop strategic clinical policy and is involved with medical/dental integration efforts, including the creation of studies demonstrating the value of integration in improving overall health outcomes. He has been with Cigna since 1996, and has worked in the dental industry for more than 30 years, including private practice. He is currently a member of the American Dental Association, American Association of Dental Consultants, and a member of the National Association of Dental Plans’ PRC Clinical Workgroup. The Cigna Dental Oral Health Integration Program® is offered to all of Cigna's dental customers. This program provides enhanced dental coverage — such as 100% reimbursement of copayments and coinsurance on certain dental procedures — for customers with specific medical conditions.

References
1. Improved Health And Lower Medical Costs: Why Good Dental Care Is Important. Cigna Corporation. 2013.
2. American Diabetes Association by Wenya Yang (The Lewin Group, Inc., Falls Church, Virginia); Timothy M. Dall (IHS Global Inc., Washington, DC); Pragna Halder (The Lewin Group, Inc.); Paul Gallo (IHS Global Inc.); Stacey L. Kowal (IHS Global Inc.); and Paul F. Hogan (The Lewin Group, Inc.). Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care, April 2013;(36).
3. Barker, Joanne. Oral Health: The Mouth-Body Connection. WebMD. Jan. 4, 2012.
4. Thomson Reuters. The Cost of Prematurity and Complicated Deliveries to U.S. Employers. Report prepared for the March of Dimes, Oct. 29, 2008.

Reference: By Miles Hall, DDS; Dental IQ

Health Organizations Call For A Ban On E-Cigarettes Indoors

 Nylaan Dental 

Tobacco control advocates disagree on whether e-cigarettes are a useful tool to get smokers off tobacco, or just a sleeker form of one of the world's deadliest addictions.

A lot of that discord comes from the fact that there's just not enough science to know the risks and benefits of e-cigarettes, which deliver nicotine in a vapor rather than through tobacco smoke. And it could take years to find out if vaping causes cancer and other deadly diseases. 

But that lack of certainty means that people need more protection, not less, according to a report released Tuesday by the World Health Organization. The global health organization called for a ban on indoor use of e-cigarettes in workplaces, restaurants and other public spaces.

OK To Vape In The Office? Cities, Feds And Firms Still Deciding

The vapors "pose a serious health threat to adolescents and fetuses," the report says, "and increase exposure of nonsmokers and bystanders to nicotine and a number of toxicants." Some studies have found that bystanders absorb more nicotine from vapor than from tobacco smoke, the report says.

One of the biggest selling points for e-cigarettes — that they can help people quit tobacco — hasn't been systematically tested, the WHO report finds. E-cigarettes are probably less toxic for smokers who switch completely, the report says. "The amount of risk reduction, however, is presently unknown."

Advertising of e-cigarettes should be banned, the report says, to reduce the risk to children and teenagers. The liquid used in the devices is often candy flavored.

And e-cigarettes don't necessarily deter young people from smoking tobacco, according to a study from the Centers for Disease Control and Prevention published Monday. Earlier studies have found a modest deterrent effect. But this study found that 44 percent of those who used e-cigarettes say they plan to try tobacco cigarettes in the next year, compared with 22 percent of those who haven't tried e-cigs.

FDA Moves To Regulate Increasingly Popular E-Cigarettes

The number of teenagers who had never smoked a cigarette but used electronic cigarettes more than tripled in three years, the study found, rising from 79,000 in 2011 to more than 263,000 in 2013. The results were published in Nicotine and Tobacco Research.

And if that's not enough, the American Heart Association issued its first policy statement on e-cigarettes, saying that the devices should be regulated like tobacco products by state and local governments, including them in smoke-free laws and taxing them to discourage use by teenagers.

In April, the Food and Drug Administration issued proposed regulations for e-cigarettes, but final rules are the focus of intense lobbying by tobacco control advocates and the tobacco industry.

Both the WHO and AHA reports voiced fears that rather than help get rid of tobacco forever, e-cigarettes could make smoking culturally acceptable once again.

The reports were issued in advance of a global health meeting in Moscow in October, where regulation of e-cigarettes will be debated.

Reference: Health News from NPR 

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Setting the record straight about Colgate Total toothpaste (Triclosan)

By: Patricia Verduin, PhD., Head of Colgate-Palmolive Research & Development

Recent media reports about an ingredient we use in our Colgate Total brand toothpaste are not based on facts or science. As we are talking about one of the best-selling toothpastes in the U.S., we want to set the record straight. 

First, it isn't just Colgate that believes in Colgate Total.  It is also the U.S. Food and Drug Administration, European, Canadian and Australian health authorities, the American Dental Association and 40 other dental professional organizations worldwide.  Colgate Total is the only toothpaste that is both approved by the FDA and accepted by the ADA. 

Colgate Total has been available to treat plaque and gingivitis for 17 years, and these problems are more pervasive than most people think. Seventy five percent of Americans face gum disease. We all have about 700 microorganisms in our mouths, and Colgate Total was created to attack those that result in gingivitis, which, if not stopped, can lead to periodontal disease and  tooth loss.  

Recently a thorough independent review was conducted by the Cochrane Oral Health Group on the oral health benefits of triclosan/copolymer, the active antibacterial system in Colgate Total. They found that after six or more months of use, as compared with traditional fluoride toothpaste, the triclosan formula delivered a 22% reduction in plaque and gingivitis, a 41% reduction in plaque severity, and a 48% reduction in gum bleeding.

Also, with the growing body of science linking oral health to overall health, Colgate Total is the only toothpaste that provides both antibacterial protection and direct anti-inflammatory action, which is an important benefit. 

Exhaustive testing has shown not only that Colgate Total provides important health benefits, but also that it is safe.  More than 90 clinical studies involving 20,000 people as well as a broad set of safety evaluations make Colgate Total the most tested and reviewed toothpaste in the world.  Colgate continues to submit annual reports to the FDA addressing new science and further safety findings.

Recent claims that triclosan in Colgate Total can lead to cancer are absolutely untrue. Global regulators have reviewed the issue of carcinogenicity and have concluded that triclosan in consumer products does not pose a human cancer risk.  

Three different studies in three different animal species have been reviewed by regulators around the world and all have concluded triclosan in Colgate Total is absolutely safe.

As for claims of endocrine disruption, the World Health Organization defines an endocrine disruptor as something harmful to one’s health, and that is simply not the case here. An examination of the full body of evidence shows that triclosan as used in personal care products does not present a risk of endocrine related health effects. This evidence includes two human clinical studies done to analyze the potential endocrine impact of triclosan in toothpaste.  Neither showed any negative effect.

No organization spends more time analyzing the health and safety of our products than we do. For more than 200 years, we have provided consumers the safest and most effective products you’ll find anywhere. We believe Colgate Total is the best, safest and most effective toothpaste available to prevent and reverse gingivitis.  I know the science and I know how it works.  It is the only toothpaste I use.

We all know that a rumor travels half-way around the world before the truth even has a chance to be heard.  But we want the truth to have a chance to catch up. We encourage consumers to look at the facts.

OUR DENTAL OFFICE'S THOUGHTS

by Brian S. Nylaan, D.D.S. 

After some preliminary research and consultations, I would agree that Triclosan is an issue that needs attention but the impact that dental applications have are minimal. Compared to the widespread usage of "antibacterials" and "antimicrobials" in thousands of consumer products, the amount of public exposure to Colgate Total toothpaste is a proverbial drop in the bucket. Today, there is a widespread phobia about getting sick and industry has responded using Triclosan based products to satisfy that desire. 

From hand sanitizers to antimicrobial shoes, we are crippling the immune systems in our bodies while adversely affecting our environment through the runoff of these products. Common sense does show the possible impact of that on the production of antibiotic resistant bacteria which kill thousands each year. Now, from a dental perspective, Colgate Total is tremendously useful in specific cases that are determined by your treatment team. 

Remember that the dosages fed to these animals greatly exceeded what you are exposed to through tooth brushing. We find the value of the antibacterial and anti-inflammatory effect of Triclosan on the body can prevent issues that go beyond just periodontal disease, such as heart attack, stroke, diabetes among others.

Truthfully, you probably would have to eat a tube of Total a day for quite awhile to build up what the rodents got in an injection. These studies look a little weak regarding the cancer link but my biggest concern lies in the environmental impact of this drug. My thought is Triclosan is valuable to the public is far fewer and more judicious applications.